Technology in the Business Office
Automating the medical business office can produce positive results.
In this Pulse article, we highlight using technology in the medical business office to produce positive results:
- Reduce manual processing errors
- Upgrade information technology to improve staff productivity
- Monitor payer payments for accuracy, identify coding errors, and monitor critical medical business processes
With the intense focus on the government's incentive program for electronic health records (EHR), it's no surprise that the business office gets the short end of the stick when practice leaders set priorities these days. While there are leaps and bounds to be made in patient flow using an EHR system, don't overlook the opportunities to enhance the revenue cycle through automation. Those options have expanded significantly in recent years, offering productivity and performance enhancements every bit as remarkable as an EHR provides for clinical operations.
Let's examine several areas where improving business processes through automation can save time and money, and perhaps, improve revenue.
Posting payments manually is time-consuming and resource intensive. Using electronic remittance, combined with electronic funds transfer, reduces staff time spent on posting payments, with the added benefit of improving cash flow. In addition to automating payments from payers, practices can contract with third parties – most often, their banks – to remit patient payments electronically using today's improved optical character recognition technology. In sum, automation today allows the vast majority of payments from almost all sources to be posted without manual intervention, allowing your staff to focus on the ones with errors.
Confirming each patient's insurance coverage is essential in today's economic climate. With patients changing employers or employment status, verifying that they have active insurance coverage is essential to getting paid. Checking eligibility for benefits also is important, as is understanding each patient's current unmet deductible.
Check your payers' websites or provider portals to download this information in bulk – calling or checking every payer's website to verify coverage patient by patient is time-consuming. Your practice management system may have a tool to automate verification. An alternative and successful approach is to work with a clearinghouse or other vendor that can accept data from your practice management system's scheduling module.
The result should be complete and expedient reporting of each patient's insurance status – a task that should be routinely performed two or three days in advance of the appointment date. Consider printing out copies of the verifications and presenting them to patients when they arrive – it will ease the process of collecting time-of-service payments from them.
If you're still paying to print and mail stacks of statements to patients each month – with many returned because of bad addresses – it's time to rethink your patient statement process. If you still believe that most patients aren't ready for online billing and payment, consider how few businesses send invoices to their customers via the U.S. Postal Service today. Indeed, many are charging customers a fee for sending paper statements.
Even if you don't institute a fee for paper billing, at least setting up a stand-alone, online payment system or a patient portal for billing and other functions. Considering that the average physician spends $8,000 on paper statements each year – not including the staff time to process payments – online billing makes good business sense. Giving patients an easier – and faster – route to pay also improves the likelihood that you'll collect what they owe.
A recent change to credit card processing rules opened the door for vendors to pre-authorize credit cards for transactions related to medical services. Practices can take advantage of this new offering by processing patients' credit cards when they arrive for appointments. Use the process to not only pay for current services due, but to place "holds" on funds for processing after the claim adjudicates.
This option also can be used to support effective patient payment plans for those who cannot pay in full all at once. For handling traditional credit cards, take the time to call around for the best rates. With more and more patients using credit, shaving even a half percent off the merchant processing fee can produce substantial savings.
Automate the code collection process with the goal of eliminating all manual entry of codes from paper charge tickets into the practice management system (PMS). Manual rekeying of codes from paper charge tickets into the PMS consumes hundreds of hours each year for physicians and their staff. It also introduces the prospect of errors through mistypes or omissions.
Options can include buying a fully integrated EHR and practice management system (PMS), building an interface between the EHR and PMS, or – if you don't yet have an EHR – capturing your charges on a tablet or PDA during the patient encounter and downloading the data into the PMS.
There is a whole new universe of effective tools to assist with the accurate application of procedure codes. Take a close look at the tools that can automatically ‘scrub' your charges to identify any coding problems at the point of entry. For example, code-scrubbing software can flag the record of the patient who is in the post-operative period so that you'll know to use modifiers for any office visits that are distinct from the patient's post-operative service package.
The National Health Insurer Report Card by the AMA (American Medical Association) reveals that the accuracy of physician payments by commercial payers is actually going down. The report reveals that commercial health insurers have an average claims-processing error rate of 19.3 percent, which is increase when compared with the previous year.
In this environment, it's wise to use technology to verify that accurate payments are received. Look for software that can examine payments at a granular level. Many practice management systems offer integrated payment monitoring or look to a contract monitoring service that – given the recent statistics on payment accuracy – may quickly prove to be worth the cost. Either way, physicians have to be part of the solution by loading the reimbursement rates dictated by each contract.
If you aren't already doing so, consider using a claims clearinghouse. Traditionally positioned as the solution that transmitted claims, a clearinghouse offers many value-added services to supplement the revenue cycle. Services may include:
- Scrubbing codes to identify problems, such as misapplied modifiers and missing linkages between procedure and diagnosis codes;
- Processing electronic remittances;
- Automating secondary claims submissions
- Verifying accurate payments
Even as your employees are being stretched thin and handling multiple new tasks, you now require more productivity from them. Analyze your downtimes and the underlying causes. Look closely at the speed of your various information systems. Slow processing times are often caused by outdated hardware, such as PCs or fax machines with too little internal memory or slow processing chips.
Even small improvements can pay off. Sit down with each employee to assess their equipment needs. Do they have software that can transmit and accept faxes on their desktop computers? Do those who must toggle between multiple programs and different systems have dual monitors? Do those who answer telephones have cordless headsets? Does everyone needing access third-party payer sites have the software and log-in information they need? Even in the business office, the old adage, ‘it's the little things that count', holds true.
Although technology can bring opportunities, spend some time to consider its application within your practice. Is the new technology streamlining work, or will its introduction add staff time and effort but not value? Is the staff adequately trained in the new processes? Does the vendor truly view its customers as partners by providing responsive customer support, training opportunities, and upgrades?
Take a step back from the excitement of automating a work process and ask: Does the new technology merely replace a paper process, or does it offer new opportunities to potential improve revenue or cash flow? Implementing technology for the sake of automation won't bring the results your practice needs; using technology to change the way you work – for the better – ushers in new possibilities.
Make sure your business office doesn't get left behind. Upgrading the technology that manages your revenue cycle will help improve cash flow, reduce costs, and enable staff to work smarter in support of you and your practice.
1. Verify Insurance
Use the Web to access payers' databases of beneficiaries. Compile reports of patients whose coverage does not match up to their registration information; call these patients to update the information or discuss payment plans for those who are no longer insured. Use payers' online portals to confirm benefits, especially when a specific service is scheduled
2. Get Authorizations
Request pre-authorizations and pre-certifications through payer Web portals. With automation, these online requests can be accompanied by electronic documentation pulled from the electronic health record to gain the necessary certifications. Use electronic systems that can check the status of each service requested and match the information to lists of patients scheduled for services; this assures that no required pre-authorization processes are overlooked.
3. Collect Balances
Give all employees who schedule appointments access to information in the practice management system so they can look for any outstanding balances as patients schedule appointments. If schedulers need to work faster than the management system link-up will allow, then use automation to match the schedule of upcoming appointments to reports of patients who have outstanding balances. Run the comparison reports two to four days before to the appointment date so that staff can target these patients for appointment reminder calls.
4. Streamline Claim Inquiries.
Use tools that automate routine claims status inquires. Automating the process of investigating claims status frees up employees to perform other, higher value tasks, such as calling patients with balances on their accounts. Claims appeals also can be automated using data documented in the electronic health record at the time of service.